Using evidence to inform practice: interventions for children with Down syndrome - PowerPoint Presentation

1. Using evidence to inform practice: interventions for children with Down syndrome Rebecca Baxter – LETS Go! UKDown Syndrome Education Internationalwww.letsgouk.org Language Education Training Speech

2. OverviewAspects of speech and language developmentSpeechVocabularyLanguage (grammar)What does the research tell us about these aspects of speech and languageExamples of interventions using this knowledgewww.letsgouk.org Language Education Training Speech

3. The profileDifficultiesCognitive delaysHearing and visionVerbal short term memoryAuditory processingPhonological representationsDifferences in anatomy and physiologyGeneralisationwww.letsgouk.org Language Education Training Speech

4. The profileStrengthsVisual short term memoryEarly communicationNon-verbal aspects of communicationImitationLearning “facts”? Reading and spellingwww.letsgouk.org Language Education Training Speech

5. 1) Speech developmentStarts early in typical developmentIn typical development, children are learning to discriminate sound in the first year of life – tuning in to native languageWhen learning a word, sound patterns needs to be held and stored Children with Down syndrome are poor at learning detailed phonological forms of words (Jarrold et al, 2009)Speech sound development influences development of phonological working memory (Keren-Portnoy et al, 2010)Speech work should start early – as research shows sound production ability influences first words in language development (Stoel-Gammon 2011) - and continue through childhoodwww.letsgouk.org Language Education Training Speech

6. What the research says about speechChildren with Down syndromeIntelligibility95% of individuals with Down syndrome have speech sound production difficulty (Kumin, 2006)Babbling – mixed information in the researchmore alike than differentbabble period is much longer and transition to words takes longerwww.letsgouk.org Language Education Training Speech

7. What the research says about speechPhonology – mixed information in the researchDodd – emergence of phonemes follows typical developmentKumin – different emergence of phonemesboth agree – huge variability and lots of inconsistency in productionDelay in phonological development increases from stage of first 10 words – about 2 years of age (Sokol, Fey 2013)www.letsgouk.org Language Education Training Speech

8. What the research says about speechPhonological processessome typical phonological processes seensome atypical processes seen – e.g. backing, initial consonant deletion, use of non-English phonemeserror patterns persist for longermore error patterns are presenterrors are more inconsistentfewer errors in imitated productionsgreater delay than would be expected by mental agewww.letsgouk.org Language Education Training Speech

9. Intervention studies - speechCore vocabulary approach (Dodd et al, 1994. Ni Cholmain, 1994)Rote practice and repetition Parent education/involvementCertain phonological processes highlightedResultsAll children in the programme showed a change in their phonological system within the first two weeksIt is possible to accelerate the phonological development and Ni Cholmain reported increase in MLU suggesting speech is holding back grammarwww.letsgouk.org Language Education Training Speech

10. Intervention studies - speechIntegrated intervention (van Bysterveldt et al, 2009)Speech, letter knowledge*, phonological awareness*Home programme, SLT session, computer ResultsSignificant treatment effects on speech measures for all participantsSome evidence of increased letter knowledgewww.letsgouk.org Language Education Training Speech

11. 2) Vocabulary developmentEarly vocabulary development is delayedThe pattern of vocabulary development is generally the same as in typical developmentTypically developing children and children with Down syndrome show huge individual variability with vocabulary Vocabulary paces grammar, just as in typical developmentMost children with Down syndrome are combining words and/or signs by 5 years of age.Teenagers often called ’telegraphic talkers’www.letsgouk.org Language Education Training Speech

12. Vocabulary/grammar link (Pennanen, Buckley & Archer 2000)www.letsgouk.org Language Education Training Speech

13. Intervention studies - vocabularyOral vocabulary learning - orthographic support (Mengoni et al, 2013)Experimental design3 trials - Repetition and phonological consolidation, Matching, ProductionResultsChildren performed better on post-training picture naming when orthography was presentBenefitted from phonological informationwww.letsgouk.org Language Education Training Speech

14. Intervention studies - languageReading and language intervention (Burgoyne et al, 2012)TA delivered programme in schoolReading strand – book reading, sight words, letters sounds and phonologyLanguage strand – introducing new word, reinforcing meaning, using new word in connected speech and in written languagewww.letsgouk.org Language Education Training Speech

15. Introducing a new word - RLIIntroduce and discuss new word: Provides written, spoken, and pictorial forms of new vocabularyTA introduces wordChild says wordChild and TA discuss word using related photosChild is shown flashcardTA and child create a word webEmphasis on relating to child’s experience, and building a rich, multi-contextual understanding15

16. Language interventionReading and language intervention (Burgoyne et al, 2012)ResultsGains on taught expressive vocabulary, single word reading, letter sound knowledge, phoneme blendingDid not see gains on standardised expressive or receptive vocabulary or expressive information and grammar www.letsgouk.org Language Education Training Speech

17. 3) Grammar developmentParticularly challenging for children with Down syndromeGrammatical morphology – tense markers, plural and possessive ‘s’, function words, pronounsExpressive language is more delayed than receptive languageNarratives vs. conversationwww.letsgouk.org Language Education Training Speech

18. Intervention studies - grammarRegular past tense (Baxter et al, PhD study)Understanding and applying the grammatical ruleTA delivered programme in schoolResultsSignificant gains on bespoke measures (taught and untaught verbs, use of past tense in story retell) and standardised measures (expressive grammar (RAPT) and regular past tense (including regularised errors) (TEGI)) No transfer to: irregular past tense or third person singularMaintained at follow up approx. 3 months later www.letsgouk.org Language Education Training Speech

19. What can we learn?The importance of applying the profile The importance of targeting individual needsThe necessity of selecting appropriate measures There is evidence of successful intervention for speech, vocabulary and grammar for this populationwww.letsgouk.org Language Education Training Speech

20. Questions and discussionwww.letsgouk.org Language Education Training Speech